FtM Breast Reduction from DD cup to B? A? Goal is to preserve erotic nipple sensation with the smallest breasts. (Photo)

Top Surgery is the #reduction and masculinization of the breasts and chest for a person who wants a more #masculine chest.  This is often an individual who desires #gender reassignment. Breast tissue is #removed and the #nipple position is usually made smaller and then placed in a more masculine #anatomic #position.  It's best to begin seeking a plastic surgeon with #board #certification and experience in this type of procedure. You should feel comfortable with your surgeon and his or her office staff. They should be open-minded regarding gender surgery. It’s important for your surgeon to have an aesthetic eye for body contouring, you should be comfortable with the surgical facility that your doctor uses and it should be certified. There are several methods used which depend upon the patient’s breast or chest #size before surgery. Considerations include the #laxity of skin, the #size of the #areola, the amount of #fat and recent weight #gain or weight #loss. The most common procedures which are described include the #periareola, #buttonhole, #double incision, and #anchor patterns. I often use #liposuction along with the double #incision for larger breasts, and, some variation for smaller breasts; depending upon the position of the areola. The female breast nipple and areola are often centered on the breast. However, the nipple and areola are lower and closer to the outside edge of the #pectoralis muscle in the male patient. Shaping the side of the chest may also be required and can be performed with #suctioning; along with contouring of the muscle, as noted above, to provide the best definition for the chest. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

Common breast reduction surgery preserves erotic nipple sensation in over 90% of patients, however there is no guarantee that sensation will be preserved for you because it is not possible to predict from person to person. The more tissue that is removed, the more likely that the hair-size sensory nerve fibers will be contained in that tissue.

I really don't think anyone can promise to preserve your erotic nipple sensation unless you had a breast reduction operation- and this would realistically still leave you with large breasts owing to the need to preserve blood supply.
For a FTM transformation you will 100% lose erotic sensation as these nerves traverse through the breast tissue to the nipple. Preserving a pedicle of tissue that contains the nerve would leave you with a mound of tissue under the nipple. It would be a cross between a reduction and a mastectomy and isn't the usual approach to this surgery so I think you'd end up with an unpredictable result- and no guarantee of preserving erotic sensation. 
Using the standard pedicle technique with a double incision will result in loss of erotic sensation as the only nerves preserved are the ones travelling in the skin.
Many patients do report a return of sensation after surgery- this is generally regular sensation, not erotic. 
I would advise seeing a plastic surgeon experienced in this type of surgery to have a thorough explanation of what is involved in the operation.
Good luck

Hi charlesford42,Thanks for the post and photos. Based on your breast size, you will require double incision with free nipple grafts. In my experience patients do initially lose sensation in the grafts but do regain some to most of their sensation back. Any other technique that will leave the nipple/areolas attached will compromise the contours that can be achieved in the free grafting technique. Sincerely,Dr. Dadvand

It may be difficult to obtain a flat chest while preserving nipple sensation.  You have a lot of excess skin and will likely require a nipple graft, which would sacrifice nipple sensation in the short term.

In an ideal surgery, the two major goals would be to make the chest as contoured/flat as possible (with the least obvious scars) and to preserve nipple sensation.  These two goals sometimes are at conflict with each other since the nerves to the nipple run through the breast tissue directly up to the nipple.  You have both excess skin with significant ptosis as well as increased breast size.  The best technique for "flatness" would be excision with free nipple grafting, however you would lose sensation with this option.  The other option would be to try to maintain the nerve supply by leaving a "pedicle" of breast tissue, however there is still a significant risk of sensation loss with this technique.  Liposuction with staged skin resection in the future (second surgery) could be considered as well and may lead to a higher rate of continued sensation, but there is still a risk of some sensory changes.  The most important thing is to find a surgeon with experience with this procedure and to convey that nipple sensation is important to you (there will be a trade off between contour and sensation)

I will be very honest, you have large breasts.  It is very difficult to make your chest look masculine, and try and maintain nipple sensation.  For someone your size, I would routinely do a free nipple graft technique. With this technique you will lose sensation.  If you try and keep the nipple sensation intact, then you will limit making your chest size small enough.  If you do a breast reduction, down to a smaller size you will still have a larger breast that will look more feminine.